June 2019 Health Newsletter

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» Chiropractic Reduces Falling Risk in the Elderly
» ACA Joins Voices Coalition to Increase Access to Non-opioid Pain Treatments
» Fit At 50 Means Less Chronic Disease
» Active Kids Think Better

Chiropractic Reduces Falling Risk in the Elderly  

 

Chiropractic Care Improves Senses and Reduces Risks of

Falling in the Elderly Population

 

By: Mark Studin DC, FASBE(C), DAAPM, DAAMLP

William J. Owens DC, DAAMLP

 

As our population ages, our most senior are being told that their heart diseases or cancers won’t be as likely to cause death as sequella from a fall. Therefore, doctors are urging that sect of population to rely more and more on canes, walkers and other devices to help offer greater support when balance issues become even slightly problematic. According to Holt et. Al (2016) “Falls account for more than 80% of injury related hospital admissions in people older than 65 years and they are the leading cause of injury related death in older adults. Approximately 30%-40% of community-dwelling older adults suffer from at least 1 fall per year.” (pg. 267)

 

Holt et. al. listed the following risks associated with falls

  1. Lower limb weakness
  2. Recent History of Falling
  3. Gait Deficits
  4. Deterioration of the sensorimotor system that occurs regularly with normal aging

 

The National Institute of Health (NIH) expanded the list of risk factors in older adults to include:

  1. Muscle weakness
  2. Balance and gait
  3. Blood pressure drops
  4. Postural hypotension
  5. Reflexes slower
  6. Foot problems
  7. Sensory problems
  8. Vision issues
  9. Confusion
  10. Medications

(http://nihseniorhealth.gov/falls/causesandriskfactors/01.html)

 

Comparatively speaking, both the Holt et. Al. and the NIH are in agreement that falling can be a multifactorial issue with often no single cause or solution. However, if an older person, who has one or more of the above risk factors can minimize those risks, the likelihood of falling can be decreased and potentially extend their life. Holt et. al. continued “There is however, a growing body of basic science evidence that suggests that chiropractic care may influence sensory and motor systems that potentially have an impact on some of the neuromuscular risk factors associated with falling.” (pg. 268) In short, the evidence has suggested that chiropractic can reduce the risk of falling in older adults.

 

Holt et. al. found that the mechanisms where chiropractic may influence sensorimotor functions are:

  1. Neuroplastic processes in the central nervous system through altered afferent input.
  2. Pain and altered cognition as a result with respect to attention focus and physical function
  3. Muscle strength and muscle activity patters
  4. Deterioration of the sensorimotor system that occurs regularly with normal aging

Looking at those neuroplastic processes or effects of chiropractic on the central nervous system, Gay et al. (2014) reported, “…pain-free volunteers processed thermal stimuli applied to the hand before and after thoracic spinal manipulation (a form of MT).  What they found was that after thoracic manipulation, several brain regions demonstrated a reduction in peak BOLD [blood-oxygen-level–dependent] activity. Those regions included the cingulate, insular, motor, amygdala and somatosensory cortices, and the PAG [periaqueductal gray regions]” (p. 615). In other words, thoracic adjustments produced direct and measureable effects on the central nervous system across multiple regions, which in the case of the responsible for the processing of emotion (cingulate cortex, aka limbic cortex) are regarding the insular cortex which also responsible for regulating emotion as well has homeostasis. The motor cortex is involved in the planning and execution of voluntary movements, the amygdala’s primary function is memory and decision making (also part of the limbic system), the somatosensory cortex is involved in processing the sense of touch (remember the homunculus) and, finally, the periaqueductal gray is responsible for descending pain modulation (the brain regulating the processing of painful stimuli).

 

This is a major step in showing the global effects of the chiropractic adjustment, particularly those that have been observed clinically, but not reproduced in large studies.  “The purpose of this study was to investigate the changes in FC [functional changes] between brain regions that process and modulate the pain experience after MT [manual therapy]. The primary outcome was to measure the immediate change in FC across brain regions involved in processing and modulating the pain experience and identify if there were reductions in experimentally induced myalgia and changes in local and remote pressure pain sensitivity” (Gay et al., 2014, p. 615). 

 

Coronado et al. (2012) reported that, “Reductions in pain sensitivity, or hypoalgesia, following SMT [spinal manipulative therapy or the chiropractic adjustment] may be indicative of a mechanism related to the modulation of afferent input or central nervous system processing of pain” (p. 752). “The authors theorized the observed effect related to modulation of pain primarily at the level of the spinal cord since (1) these changes were seen within lumbar innervated areas and not cervical innervated areas and (2) the findings were specific to a measure of pain sensitivity (temporal summation of pain), and no other measures of pain sensitivity, suggesting an effect related to attenuation of dorsal horn excitability and not a generalized change in pain sensitivity” (Coronado et al., 2012, p. 752).These findings indicate that a chiropractic spinal adjustment affects the dorsal horns at the root levels which are located in the central nervous system.  This is the beginning of the “big picture” since once we identify the mechanism by which we can positively influence the central nervous system, we can then study that process and its effects in much more depth.    

 

One of the main questions asked by Corando et al. (2012) “…was whether SMT (chiropractic adjustments) elicits a general response on pain sensitivity or whether the response is specific to the area where SMT is applied. For example, changes in pain sensitivity over the cervical facets following a cervical spine SMT would indicate a local and specific effect while changes in pain sensitivity in the lumbar facets following a cervical spine SMT would suggest a general effect. We observed a favorable change for increased PPT [pressure pain threshold] when measured at remote anatomical sites and a similar, but non-significant change at local anatomical sites. These findings lend support to a possible general effect of SMT beyond the effect expected at the local region of SMT application (p. 762).

 

The above mechanisms take the effects of chiropractic care out of the realm of theory and validates the processes through which chiropractic works based upon the scientific evidence (literature).

 

 

Holt et. Al found that outcomes measured for both sensorimotor and quality of life increased with chiropractic care. The primary outcomes of improvement choice stepping reaction time (CSRT)and sound-induced flash illusion. The CSRT involves feet placement in a timed scenario and sound-induced flash illusion involves multisensory processing to ascertain reaction to perceived illusions. Both have been significantly related to older populations and falling. Although the results of this study has its limitations, as many studies do. Holt concluded” The results of this trial indicated that aspects of sensorimotor integration and multisensory integration associated with fall risk improved in a group of community-dwelling older adults receiving chiropractic care. The chiropractic group also displayed small, statistically significant improvements in health-related quality of life related to physical health when compared with a “usual care” control. These results support previous research which suggests that chiropractic care may alter somatosensory processing and sensorimotor integration.” (pg. 277)  

 

As with many of our articles from here forward, I would like to leave you with a last and seemingly unrelated statement.  I felt it was important to add this at the end since many of our critics negatively portray the safety of chiropractic care.  This statement shall put that to rest leaving only personal biases left standing. Whedon, Mackenzie, Phillips, and Lurie (2015) based their study on 6,669,603 subjects and after the unqualified subjects had been removed from the study, the total patient number accounted for 24,068,808 office visits. They concluded, “No mechanism by which SM [spinal manipulation] induces injury into normal healthy tissues has been identified” (Whedon et al., 2015, p. 5). This study supersedes all the rhetoric about chiropractic and stroke and renders an outcome assessment to help guide the triage pattern of mechanical spine patients.

 

References:

  1. Holt K., Haavik H., Lee A., Murphy B., Elley C., (2016) Effectiveness of Chiropractic Care to Improve Sensorimotor Function Associated with Falls Risk in Older People: A Randomized Controlled Trial, Journal of Manipulative and Physiological Therapeutics, 39(4) 267-278
  2. Falls and Older Adults, Causes and Risk Factors (n.d.) National Institute of Health, retrieved from: http://nihseniorhealth.gov/falls/causesandriskfactors/01.html
  3. Gay, C. W., Robinson, M. E., George, S. Z., Perlstein, W. M., & Bishop, M. D. (2014). Immediate changes after manual therapy in resting-state functional connectivity as measured by functional magnetic resonance imaging in participants with induced low back pain.Journal of Manipulative and Physiological Therapeutics, 37(9), 614-627.
  4. Coronado, R. A., Gay, C. W., Bialosky, J. E., Carnaby, G. D., Bishop, M. D., & George, S. Z. (2012). Changes in pain sensitivity following spinal manipulation: A systematic review and meta-analysis, Journal of Electromyography Kinesiology, 22(5), 752-767.
  1. Whedon, J. M., Mackenzie, T. A., Phillips, R. B., & Lurie, J. D. (2015). Risk of traumatic injury associated with chiropractic spinal manipulation in Medicare Part B beneficiaries aged 66-69 years. Spine, 40(4), 264-270.

Author:Mark Studin DC, FASBE(C), DAAPM, DAAMLP and William J. Owens DC, DAAMLP
Source:US Chiropractic Directory
Copyright:2016 2016


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ACA Joins Voices Coalition to Increase Access to Non-opioid Pain Treatments  

The American Chiropractic Association (ACA) has joined forces with Voices for Non-Opioid Choices ("Voices"), a nonpartisan coalition of more than 20 organizations committed to preventing opioid addiction before it starts by increasing patient access to non-opioid therapies and approaches for managing acute pain.  Chiropractors' use of spinal manipulation as a non-drug approach to back pain treatment is especially relevant in combating the U.S. opioid epidemic.  Low back pain is one of the most common conditions for which prescription opioid pain medications are prescribed even though research shows the drugs have limited effectiveness in relieving back pain and carry higher risks.  The Voices coalition seeks to increase access to multiple non-opioid and non-drug approaches so that patients can manage their pain more safely and effectively--particularly pain after surgery.  According to Voices, pain after surgery is a common path to opioid abuse, misuse and addiction, with about 3 million Americans becoming "persistent" opioid users each year following a surgical procedure.  The Voices coalition includes both patient and provider organizations such as the American Nurses Association, the Alliance of Orthopaedic Executives, the American Medical Women’s Association and the National Safety Council.  "We are excited to join Voices and its efforts to increase access to non-opioid approaches to pain treatment.  Chiropractic services and other non-drug approaches are an important first line of defense against pain," said ACA President Robert C. Jones, DC.  "Beyond the risks of addiction and overdose, prescription opioid medications that numb pain may convince a patient that a musculoskeletal condition such as back pain is less severe than it is or that it has healed. This misunderstanding can lead to overexertion and a delay in the healing process or even permanent injury."

The American Chiropractic Association (ACA) is the largest professional chiropractic organization in the United States.  ACA attracts the most principled and accomplished chiropractors, who understand that it takes more to be called an ACA chiropractor.  We are leading our profession in the most constructive and far-reaching ways -- by working hand in hand with other health care professionals, by lobbying for pro-chiropractic legislation and policies, by supporting meaningful research and by using that research to inform our treatment practices.  We also provide professional and educational opportunities for all our members and are committed to being a positive and unifying force for the practice of modern chiropractic.

Author:ChiroPlanet.com
Source:Acatoday.com; May 20, 2019.
Copyright:ProfessionalPlanets.com LLC 2019


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Fit At 50 Means Less Chronic Disease  

In a finding that should come as a surprise to no one, a new U.S. study concluded that physically fit 50 year olds suffered less from chronic conditions like heart disease, diabetes, Alzheimer's disease and colon cancer, as they aged. The study of over 18,600 men and women, linked treadmill tests, done at the age of 50 and meant to establish cardiovascular health, to an additional 26 years of Medicare claims. Men in the lowest fifth of fitness scores in the initial evaluation experienced a rate of chronic disease of 28 percent per year. In contrast, the the rate of the top fifth was 16 percent per year. In women, the rates were 20 percent and 11 percent. Currently, national guidelines recommend 150 minutes of moderate-intensity exercise or 75 minutes of high-intensity exercise per week. While the findings do not prove that exercise cuts the risk of chronic disease, it does appear that it makes a difference as we age. However, researchers added that the study did not take into account genetic and environmental factors which may affect the chronic disease rates.

Author:ChiroPlanet.com
Source:Archives of Internal Medicine, online August 27, 2012.
Copyright:ProfessionalPlanets.com LLC 2012


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Active Kids Think Better  

According to researchers, children who participate in moderate to vigorous physical activity not only benefit physically, they also improve their cognitive performance and brain function. Results from a new study involving 221 children aged 7 to 9 show regular participation in moderate to vigorous physical activity increases their ability to block out distractions, increase focus and improve their multi-tasking skills. U.S. and European exercise guidelines for children and teens currently call for a minimum of 60 minutes of moderate to vigorous physical activity per day. If you're a parent with a child or teen, encourage and assist them in becoming and staying physically active. Enroll them in after school programs that involve physical activity. Get them into a sports league. Join the YMCA. Take them to the park. Play in the back yard. Be safe but definitely be active!

Author:ChiroPlanet.com
Source:Pediatrics, online September 29, 2014.
Copyright:ProfessionalPlanets.com LLC 2014


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